Failure to Provide and Document Scheduled Showers and Hygiene for Dependent Residents
Penalty
Summary
The deficiency involves the facility’s failure to provide and document scheduled showers and hygiene assistance for multiple dependent residents, contrary to its Bathing-Shower and Tub Bath Policy and Nail Care Policy. The bathing policy requires that residents be offered a shower, tub bath, or bed/sponge bath at least once per week or according to preference, and the nail care policy requires nail assessment and cleaning during bathing. For one cognitively intact resident with dementia, fibromyalgia, osteoporosis, and mobility deficits, the care plan and MDS documented dependence on staff for showering and bathing, yet the medical record showed no showers over nearly two months. This resident reported never receiving a shower during the stay and stated that staff said they did not have time when showers were requested. The Corporate Interim DON confirmed there was no shower documentation and that shower sheets were no longer used. Another resident with heart failure, anoxic brain damage, chronic respiratory failure with hypercapnia, and COPD was documented as bedfast and dependent on staff for all ADLs, including showers. The medical record contained no documentation of showers, and a nursing note recorded a family complaint that the resident was not receiving showers. The note indicated the resident had not been assigned a shower day in the system and that hygiene was reportedly maintained with bed baths while the resident was on isolation precautions and unable to use the community shower room. The family member stated the resident went without a shower for two to three weeks and believed bed baths were not being done based on the resident’s appearance. The MDS Coordinator later verified there was no documentation of showers for this resident. A similar lack of documentation occurred for another resident with diffuse traumatic brain injury, tracheostomy status, and acute respiratory failure, whose care plan and MDS showed total dependence for ADLs and personal hygiene. A family member reported that this resident was supposed to receive two showers per week but had only one shower in a month and one shower in the prior three to four weeks, and the MDS Coordinator confirmed no shower documentation. Additional residents with ADL self-care deficits and dependence on staff for hygiene also lacked documented showers or baths over extended periods. One resident with metastatic lung and brain cancer, failure to thrive, muscle wasting, and gait abnormalities was care planned to receive substantial/maximal assistance for hygiene and bathing, yet the electronic record showed no showers or baths since admission. The resident’s family reported only two showers over several weeks and stated the resident was not wiped down daily; observation showed long, thick toenails, a shirt with white skin flakes and debris, and discolored fingernails. Another resident with dementia, requiring assistance for bathing, dressing, grooming, and nail care, had no documented showers for at least two months; observations on two dates showed long fingernails with orange/yellow crusted debris, and a CNA acknowledged the nails were dirty and should be cleaned during showers. A further resident with hemiplegia and total dependence on staff for all care and hygiene also had no documented showers for at least two months. The DON confirmed there was no documentation of showers for these six residents and stated that CNAs were expected to document showers electronically, with no paper shower sheets in use.
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